I recently got blood work back stating that I had a positive test for Hep D. I know this virus needs Hep B to replicate. I tested positive for Hep B when I found out I was HIV positive 15 years ago. All my liver tests have been normal to this point. I am on Ziagen, 3TC, and D4T and have been undetectable for over 6 months on this combo and cd4s were 720 at last count. When I tested positive for Hep B I was told there was nothing to worry about (of course that was 15 years ago). Now that I've tested positive for Hep D I'm worried. Is there anything I should be monitoring, or further testing I should have? I don't ever remember having symptoms of Hep B.

Scott, Atlanta

Response from Dr. Cohen

Hepatitis D, sometimes called the "delta agent", is a type of viral infection of the liver that can only be acquired by someone with either chronic (ongoing) hepatitis B, or in the early stages of a new hepatitis B infection. In most people (90%) hep B virus is cleared away within weeks to months of infection, and at this point they are protected from reinfection and can no longer get Hep D either. The hepatitis B virus is "required" to initiate infection with delta agent.

This means that you either got Hepatitis D at the same time as you got Hepatitis B, or you were one of the 10% who got chronic hepatitis B and later picked up the delta agent. Whatever the case, you probably now have a form of chronic hepatitis, though your normal liver function tests are a very good sign.

It isn't uncommon at all for adults to have a case of hepatitis B and have few if any symptoms. This is one reason that every HIV positive person should be checked for immunity to hep B, and vaccinated if they are not immune from natural infection. Also, persons with chronic hepatitis of any type need to be watched more carefully for liver problems, which can occur with many HIV drugs.

In general, anyone with chronic hepatitis (such as B, C, or D) should have regular close monitoring of liver function if they are on HIV drugs. You should also consider seeing a liver specialist, who may screen for other possible liver problems. This could include a liver biopsy to check directly for cirrhosis or scarring. This may be a very good idea, because liver function tests can sometimes be normal even in the presence of significant damage. The biopsy itself is pretty straight-forward -- don't skip it if a specialist tells you it is needed. You will need to avoid drinking alcohol, and talk with your doctor about eliminating or changing any unnecessary meds.

As I said, it is very reassuring that you are doing so well on your combo! That counts for a lot, and probably indicates a good prognosis for the future. Still, Hepatitis D is serious, so be sure to have a thorough evaluation by your doctor and/or a liver specialist. Good luck.

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